Provider Demographics
NPI:1366672347
Name:FREEDOM TO BE, LLC
Entity Type:Organization
Organization Name:FREEDOM TO BE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPCC
Authorized Official - Prefix:MR
Authorized Official - First Name:DARCY
Authorized Official - Middle Name:SULLIVAN
Authorized Official - Last Name:CLARKE
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:505-474-6368
Mailing Address - Street 1:2100 CALLE DE LA VUELTA
Mailing Address - Street 2:BLDG. D; UNIT 206
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4742
Mailing Address - Country:US
Mailing Address - Phone:505-474-6368
Mailing Address - Fax:505-474-6368
Practice Address - Street 1:2100 CALLE DE LA VUELTA
Practice Address - Street 2:BLDG. D; UNIT 206
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4742
Practice Address - Country:US
Practice Address - Phone:505-474-6368
Practice Address - Fax:505-474-6368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-23
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0085671302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization